Older People Respond Better Than Younger People to Treatment for High Blood Pressure

May 18, 2000

New York (MedscapeWire) May 22 — New data from the Hypertension Optimal Treatment (HOT) study show that older hypertensive people (older than 65 years), when treated with a felodipine extended release (Plendil) antihypertensive regimen, achieve lower blood pressure levels than younger patients. They are less likely to experience adverse effects from treatment, and they reach blood pressure targets more easily. These findings, which were published in the May issue of the Journal of Hypertension, have important implications for the treatment of high blood pressure in the elderly.

The HOT results show on average a 1 to 2 mm Hg lower blood pressure measurement in the treated older patients compared with the treated younger patients, and older people reach target blood pressure levels on fewer drugs than younger people. Older patients also experienced adverse effects such as coughing and headache less often than younger patients.

Commenting on the results, lead author Sverre Kjeldsen, MD, of the Department of Cardiology, Ullevaal University Hospital, Oslo, Norway, said: "Earlier data showed that a decrease in blood pressure of 5-6 mm Hg led to a 42% decrease in the risk of stroke and a 14% decrease in the risk of heart disease. The 1-2 mm Hg lower diastolic blood pressure observed in the HOT study when comparing young and old is, therefore, important. There is now compelling support for the use of a calcium antagonist-based regimen in the treatment of the older hypertensive."

These results further add to the growing body of evidence of a marked decrease in cardiovascular risk of up to 43% that can be achieved if older patients have their high blood pressure effectively managed.

Traditionally there has been a reluctance to aggressively treat the older hypertensive patient. Evidence is growing to encourage intervention in the elderly and the World Health Organization - International Society of Hypertension (WHO-ISH) guidelines now recommend a target blood pressure of 140/90 mm Hg for the elderly patient. This means that blood pressure levels considered to be acceptable in the past may now be seen as too high.

The increase in life expectancy for both men and women has led to an aging population, and increasing age leads to increased cardiovascular risk. Cardiovascular disease is, therefore, a growing problem; by 2020, cardiovascular disease is expected to replace infectious disease as the world's leading cause of death and disability.

The HOT study is the largest intervention study in hypertension ever completed, and almost one-third of the 18,790 patients were 65 years or older.